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Obstructive sleep apnea in 2–6 year old children referred for adenotonsillectomy

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Abstract

Purpose

Adenotonsillectomy is one of the most common surgical procedures performed in children. The indications for surgery are either frequent recurrent throat infections or hypertrophy of the tonsils/adenoid vegetation, which can cause obstructive sleep apnea (OSA). There is disagreement regarding the need for sleep studies before adenotonsillectomy to confirm a diagnosis of OSA. Several studies have evaluated questionnaires and physical examination as tools to identify OSA, with conflicting results. The aim of this study was to evaluate the prevalence of OSA among children referred for adenotonsillectomy and whether questionnaires or physical examination can help identify OSA.

Methods

This is a prospective cohort study of children aged 2–6 years, referred for adenotonsillectomy. Polysomnography and an otorhinological examination were performed. Tonsillar size and the oral cavity were graded using Friedman’s classification and Mallampati score, respectively. The Pediatric Sleep Questionnaire (PSQ) and OSA-18 were also completed.

Results

100 children were included. The prevalence of OSA was 87%, with 52% having moderate to severe OSA. The usefulness of the PSQ and OSA-18 for detecting OSA was evaluated using multiple cutoff points, but none yielded acceptable values for both sensitivity and specificity. In logistic regression analyses predicting different levels of OSA severity, age, Friedman tonsillar size and Mallampati score were weakly associated with OSA.

Conclusions

The prevalence of OSA is high among children referred for adenotonsillectomy and questionnaires and clinical characteristics are not sensitive enough to detect the presence or severity of OSA.

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Authors and Affiliations

  1. Pediatric and Adult Sleep Disorder Clinic, Lovisenberg Diaconal Hospital, Postboks 4970, Nydalen, 0440, Oslo, Norway

    Britt Øverland & Hanne Berdal

  2. Department of Otorhinolaryngology/Head and Neck Surgery, Oslo University Hospital, Oslo, Norway

    Harriet Akre

  3. Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Harriet Akre

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  1. Britt Øverland
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Correspondence to Britt Øverland.

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Author B. Ø.: declares that se has no conflict of interest. Author H.B.: declares that se has no conflict of interest. Author H. A.: declares that se has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and is later amendments or comparable ethical standards.

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Øverland, B., Berdal, H. & Akre, H. Obstructive sleep apnea in 2–6 year old children referred for adenotonsillectomy. Eur Arch Otorhinolaryngol 276, 2097–2104 (2019). https://doi.org/10.1007/s00405-019-05362-3

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